The rate of death for all addictions is high. Opiates aren't special. Aside from the sheer misery factor, which I am certainly not discounting, opiate detox/withdrawal is not one of the more dangerous ones. It's super miserable for sure, but opiate withdrawal doesn't kill people. Alcohol withdrawal kills people. Benzo withdrawal kills people. Opiate withdrawal does not.

The whole rehab business is screwed up. I agree. Free or low cost rehab and detox programs are disgustingly underfunded. Private rehab programs are disgustingly expensive. Insurance companies disgustingly refuse to pay. It's a hot mess all around. I think it sucks that a (relatively) comfortable detox and inpatient rehab and real help all around is reserved for the financially comfortable and the few extremely lucky people who get into state run or charity based places. I think it sucks that some programs run more as a spa vacation for the rich and powerful and others prey off of promising rich parents that they'll cure their addict child and make them able to drink and use recreationally like a normal person (I'm looking at you, Passages Malibu). I think it sucks that millions of addicts genuinely want to be clean and don't know how and don't have the means to buy real help. I think it sucks that addiction is so woefully misunderstood, stigmatized, and underfunded as a legitimate medical and scientific field. I think it sucks that rehab has such a high failure rate (between 40-90%, the statistics suck because the area is so understudied and underfunded). But despite all of that, it's still the best option we've found so far. Twelve step programs are the only long term success we know of (despite the fact that they can be admittedly annoying), and yeah, what little data we have on their success still looks abysmal, but it's the best we have so far. And that fucking sucks. I know it.

But none of that makes suboxone a cure. Suboxone fucking sucks too. It's dangerous, it's deadly when mixed with behaviors that we know addicts do, it's addictive, it has shitty withdrawal, it still causes impaired judgement and thinking, and to top it off, even when it's useful, it's a pain in the ass to get. And sometimes it also falls into the "lesser of two evils/it sucks but it's the best we can do" category. But suboxone is meant to be a tool used with a bunch of other tools to get through the worst of withdrawal, and then stopped. Thinking of it as a magic cure for addiction is dangerous.

Twelve step programs and reputable rehabs are very up front about the high rates of failure. But the fact that they don't work for everyone every time doesn't make them a scam. The fact is, housing someone 24/7 and following the strict laws, feeding them, medicating them, teaching them, and paying the staff that cares for them is expensive. And 12 step programs don't even charge any money and often give away supplies for free, which would make them a shitty scam. If a cancer patient undergoes chemo and it doesn't work, it's not a scam. Medicine isn't car repair, there are never guarantees. A treatment that has a margin of error, even a large one, but offers a chance of recovery greater than the chance of recovery doing nothing offers, is still a legitimate treatment as long as the margins of error are disclosed. There are scams out there, and just like with other areas of medicine, they are able to be found by their guarantees and claims of 90-100% recovery rates.

Too many addicts do die, even with treatment. Addiction is fucking awful and it's heartbreaking. But until science and medicine understand how to treat addiction better, the options with depressingly low success rates are still better than the option with zero success.